Acne or gram-negative folliculitis

18 year old girl with no significant past dermatological history presented with nodulocystic lesions since 1 year duration. She was started on a tetracycline which resulted in flaring of lesions. She was then started on Isotretinoin 20 mg morning and 10 mg night for 1 month and 20 mg twice daily in the second month. Now patient complaining of pain beneath acne lesions without significant improvement in terms of acne lesions. Is this still a case of acne vulgaris? Or does the patient require modification to current treatment?

More about this case

Trending cases

Similar Cases

Woman in her 50's, no relevant priors except for multiple CVRF. Lesions on her nose for 1 year, slowly increasing in size. Started on doxycycline for 2 months with no improvement. A biopsy was done, which revealed granulomas with a marked lymphocytic infiltrate, in a probable context of granulomatous rosacea. PCR for M. Tuberculosis was negative. We started her on isotretinoin 20 mg/day, with only mild improvement (first photo is after 2 months of isotretinoin, second photo when she presented to our department). Any suggestions?

Seventy-three-year-old female patient with a personal history of depression and osteoporosis. Current treatment: calcium supplements, bisphosphonates, paroxetine 20 mg and lormetazepam 2 mg

She comes to the consultation due to a raised melanocyte lesion in the dorsal region with progressive growth over the last few months associated with occasional itching and pain. What diagnosis do you consider most likely prior to a biopsy?

This patient came in to urgent care requesting an acne cream for this "zit" that would not go away. States that she has had it for months; started small and that it will bleed and crust but will not go away starting to become a bit painful. Our doctor referred her out for a skin biopsy. Does this look like some sort of skin cancer? This is right in the middle of the forehead patient in her mid-20’s.

68 years old, female. Housewife. She is hypertensive and diabetic. She uses Atenolol 50 mg/day, Enalapril 20 mg/day, Metformin 1 gram/day and Glibenclamide 10 mg/day. 20 days ago she began to feel itching in the trunk region and proximal area of the upper and lower limbs. She used Loratadine, Permethrin 5%, Prometazine, without improvement of the itching. After that she noticed the appearance of an elevated lesion in the left dorsal region. She felt a lot of pain and the injury grew and began to drain pus spontaneously. Soon after, another injury, with the same characteristics, appeared in the left lumbar area, also draining spontaneous pus. I noticed similar lesions, but in the early stage in the legs, inguinal region and gluteum. Patient used Cefalexin in another service for 7 days, with no improvement. Patient was then submitted to surgical drainage, with removal of purulent material from the two lesions and Clindamycin 1.2 grams/day and occlusive dressings with Collagenase + Chloramphenicol were started. What can these injuries be?

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ECG that would warrant further work-up or is this just a pediatric ECG?